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It is great to get feedback so quick. I'm anxious today. I have 4 people I know who have had various surgeries for obesity and all are relieved and happy for the help with their problem. I have been going through all sorts of issues, denial, anger and finally accepting that this is something I can do and succeed with. I really thought I was loosing my mind last summer but it was all sorts of denial and avoidance stuff going on. ( I also have low oxygen issues, bad sleep and breathing issues from the fat...so those symptoms sent me on a wild goose chase as well.) What seems so silly now is that I knew always that most if not all my health issues are about the obesity. Then sometimes the medication for the complications of it...all sorts of stuff was in place to support avoiding of the root of the problem. In my family of origin alcoholism is an issue. I have been so angry sometimes that drug addicts and alcoholics have been treated with more respect for their disease than I have for mine. Alcoholism was easy to recover from compared to this...I hope with the success of these surgical procedures we can all begin to get what we need. I am already beginning to come up substitutes for masking my emotions with food...( can ya tell...like venting here to people I don't even know?...I am normally so mild and sweet...yahh.) I think it will be a really good thing to remove the option of emotional eating...I suspect my house will be cleaner, music will be louder and garden will be amazing...( always my favorite therapy..) Funny thing is that I haven't actually enjoyed eating in a long time...It's more like just a negative behavior. It will be interesting to see what goes on here ...I think it will be tricky but probably the only way to go. And whatever it takes will probably be an improvement over this. A few years ago the stars aligned (so to speak) and I actually) managed to take off 50 pounds... At one point my eating was a bit bullet proof. I mean I just was not interested in overeating. It actually lasted for almost an year and a half and I felt so good! It was a mini miracle, and unfortunately life stresses came back and I reverted to my usual coping mechanism. I am hoping this tool will keep me where I need to be. I don't mind the possibility of being an emotional wing ding instead of a fat, sick, nearly dying sweetie pie. Good luck and hope for improving health to all of us..and thanks for being out there. love

My surgeon advised during her seminar that you SHOULD choose lapband if you don't want to give up alcohol entirely. Current thinking is that alcohol can be very dangerous for gastric bypass because the alcohol goes straight into the system of a GB patient without being metabolized at all by the stomach. With lapband, the processing of alcohol is not changed at all. I will warn you that it may make your band feel tighter the next morning, though. Since alcohol is a diuretic, the rebound effect the next day may cause you to retain water which can make your band feel tighter.

Imma say something blunt: If alcoholics can kick alcohol and diabetics can kick sugar, you can kick sugar, too. I don't know everything you'll need to do, but here are some obvious changes to make: * Don't buy it. * Don't let anyone else in your house buy it and bring it home where you could eat it. * Become more personally accountable and become more accountable to others, e.g., tell those you spend time with that you're not going to eat any more sugar. * Invite the support of those who love you (see above) and ask them to support your new sugar-free lifestyle. * If you really think you're an addict (you used that word, I think), then treat it like an addiction and get yourself into an addiction program, either out- or in-residence. * Stop regarding and using sugar like a treat. If you're an addict, it's dangerous to you. Treat it like poison. * Figure out what other activities or things you can use as rewards instead of sugar. * Don't hang out with people who eat a lot of sugar. * Identify all the hidden sugar in foods you are now eating that you think are sugar-free. I'll guarantee you there are some sugar-laden foods somewhere in your diet right now that you don't know about yet. * ... and other things. I know you know this, but the longer you go without eating any sugar, the less you will crave it. Good luck! I appreciate that you replied to my post and offered some tips. Please correct me if I'm wrong, but some of what you said reminds me of people who say no one really needs bariatric surgery. We just need to be more personally accountable and diet and exercise. Do you not see bariatric surgery as a tool for dealing with obesity and kicking the things that made people obese in the first place?

Let me remind everyone that recent studies have shown that all fluids, regardless of whether or not they contain caffeine, are equally hydrating (with the exception of alcohol). So in reality, Coke and Water hydrate the body equally. As for the other facts about the other stuff in it, I'm not too sure, but in terms of hydration, coke or water will both do the trick.

Exactly why I am doing this study. People ask this question so many zillions of times a month. I am going to have data to share for the one zillion and one time someone asks when they can have alcohol and why can't they have beer, etc.

I don't think it's a good idea either. Your stomach is basically new, like a babies stomach. That's why we start at liquids, the work our way up to solids again....so that our stomach can heal. Alcohol is very strong and has a lot of sugar. You may dump:( I'm sorry that you can't celebrate with alcohol, but just having this surgery is a celebration in itself:)) Happy Birthday!!

My dr said to avoid beer and wine if I had to have a Coctail a 1/2 shot of good vodka was best due to the way the sugar breaks down. Maybe it's slower in vodka so the stomach can process it better since it's so small. She recommended having it with A sugar free beverage-not straight shots and to nurse it. Again, they recommend waiting 3 months which won't be until Jan. 11th for me. To tell you the truth, I'm struggling with food at every meal -I don't need more worries or issues by experimenting with alcohol! My husband's 50th B'day is Jan. 25 so maybe I'll indulge that night!

With doing the boot camp exercising, your body is changing; and a weight gain is not uncommon as you are building muscle, not fat. That being said, STOP the alcohol as much as possible; all empty calories!!! Have Water with some fruit in it (or bring one of those flavor dispenser/packets with you)...be the designated driver... that stuff is not doing you ANY favors... Next find out if there is a bariatric center near you and if they have meetings, a lot of centers have to have a monthly meeting for post-bariatric members to keep their certification. It has been proven that if you attend these meetings you are more likely to succeed in your endeavor! Helpful hints are always given at these, including easy recipes! try "The World According to Eggface" for recipes, she's got some great stuff... your weight loss is nothing to sneeze at...it's great! when was the last time you lost that much weight in that amount of time?!?! If you are like the rest of us, the answer is "never"! Don't discount yourself...you can't compare yourself to others! And lastly, remember, Protein FIRST! Good luck, you've got this!

It been over a year since my surgery. I was told I can have alcohol, so I tried a wine cooler last night. it cause real bad stomach pains. Still dealing with pains today. So I was wondering anyone else have problems with it ? I don't even want to try again at all.

I was told 1 year before having alcohol. I waited about 3 months and it didn't do anything to me! But then.... It hit me about 5 months post op... It almost makes me sick (not sure if I'm happy about this part). I have drank a small margarita (skinny) and felt plastered. I'm still debating on whether it's worth it at all. It sure would save me $$$! Sent from my iPhone using the BariatricPal App

I think learning to see ourselves differently is a huge part of our process, and that also means seeing others differently as a byproduct. It isn't uncommon, for example, for someone recovering from addiction to alcohol to see anyone who drinks at all as an addict. That kind of oversimplification often doesn't last, it's part of the process. I agree that judging others isn't wise or helpful. We don't know the stories or struggles of others, and I don't feel sorry for other, either. That puts me in a place of presuming at least part of their story. The person I see at the grocery story who looks 100 lbs overweight and barely able to walk may in fact have lost 100 lbs and be walking today where they couldn't before. It's all too easy to think of ourselves as superior because we're making positive changes in our lives, y'know?

Hello! If you band had slipped then more than likely you would be in some serious pain! I have had to play a lot with my fills (Take 1cc out, add 1cc etc.) as of lately and it's just something that comes with the band. In the morning, you should try drinking a warm/hot beverage like green tea. It helps to relax the smooth muscle (your esophagus) and open you up a bit. I usually have about 2 in the morning and I find that it helps me. As far as the alcohol and carbonated beverages go, I already have Acid Reflux problems and both aggravate it. My suggestion would be to cut down on both. If that doesn't help, you band may just be too tight and you might have to have 1cc or 1/2cc taken out to fix the problem... hope this helped!

I was just surprised at even in my pre-op testing, or in getting my clearances, or even when I had my surgery was there ever a concern and even in reading all of my test results the numbers seems normal. I did look at my labs after my surgery and see that there is a difference though as the absorption rates change and though I've changed my diet/lifestyle for the past 9 months it will get better. I did talk to a specialist that mentioned this is normal for a short period after surgery which is why they say to avoid alcohol and all of the fatty foods we shouldn't be eating in anyway. The liver has to work in overtime a bit due to the change in diet and until we are "normalized" per se, that will remain the case with the liver. Thank you for the information and i'm glad I am not alone in this.... everything else has been good, I was just surprised by this but I suppose it is a learning process for me just as much as it is for me PCP as well as he doesn't have many patients who've had WLS surgery. I did start Biotin and Vitamin D3 though. So hopefully that will help some as well.

LAPAROSCOPIC GASTRIC SLEEVE DIET Introduction The following information provides guidelines for you to follow before and after Gastric Sleeve Surgery and for the rest of your life. Gastric Sleeve Surgery is a weight loss tool. After surgery, you will be required to make lifelong changes in your eating habits and to exercise on a regular basis in order to achieve and maintain your weight loss goals. Gastric Sleeve Surgery reduces the size of the stomach which restricts the volume of food that you can consume at one time. This means that you will feel full after eating a small amount. The surgery also induces hormonal changes which help prevent you from feeling excessively hungry. You should avoid drinking liquids with meals. This is to prevent overfilling of the stomach. Frequent snacking or grazing must also be avoided as this contributes to excess calorie intake and can slow weight loss or cause you to gain weight. Exercise is an important component of weight loss success. Exercise is recommended before and after surgery in order to maximize the amount of weight that you lose and keep off. If you have not been an active exerciser, always consult with your physician for clearance and recommendations before beginning any exercise program. It is important to follow the lifetime Gastric Sleeve diet rules, supplement guidelines, and exercise recommendations in order to achieve and maintain optimum weight loss success. In order to begin preparing for surgery, start implementing the pre-surgery diet goals listed on the next page. 4 Pre-Surgery Diet Practice Tips 1. Choose low-fat foods, and avoid fried foods. 2. Stop using sugar. Use sugar substitutes such as Sweet & low, Equal, or Splenda. 3. Decrease intake of Desserts and candy. 4. Stop drinking sugar-sweetened beverages such as regular soda and sweetened Kool-Aid. 5. Start weaning off of caffeine and carbonated beverages. 6. Start cutting back on fast food and eating out. Begin making healthy meal choices when eating out and at home. 7. Eat 3 meals a day. Do not skip Breakfast. 8. Start decreasing portion sizes. 9. Eat more fruits and vegetables. 10. Practice drinking water and other fluids between meals, not with meals. 11. Drink 64 ounces Water a day. 12. Practice sipping liquids. 13. Avoid alcohol. 14. Begin some form of exercise. 15. Review the following information on the gastric sleeve diet. 16. Practice chewing foods thoroughly, 20 - 40 times or to paste consistency. 17. Purchase your protein drinks or supplements. 18. Purchase your vitamin and mineral supplements. 19. Begin planning a schedule for mealtime, fluids and Vitamin and mineral supplements. 5 Post Gastric Sleeve Surgery Diet Important Diet Guidelines: 1. Eat 3 meals per day. Avoid snacking and grazing. 2. Eat small amounts. Initial portion size should be no more than 1 - 2 ounces - approximately 2 - 4 Tablespoons - of food per meal for the first month. At first you may not be able to tolerate this amount. Over time, you will slowly tolerate more volume at each meal. Long term, the stomach will eventually hold about 4 - 8 ounces (1/2 - 1 cup) of food per meal. 3. Eat Protein foods first. 4. Do not try to eat food and drink liquid together. • Consume liquid 30 to 60 minutes before and/or 30 to 60 minutes after eating meals but not during meals. 5. You are required to take a multi-vitamin with minerals for the rest of your life. 6. Eat slowly! • Each meal should last 30minutes or longer. • Avoid gulping foods and drinks. • All foods must be well-chewed to a paste consistency. • Using a small fork or spoon (i.e. baby utensils) can help control portion sizes. • Have one place to eat (such as at the table) and avoid reading or watching TV while you eat. This helps you to enjoy your food, concentrate on eating slower and to realize when your stomach is full. 7. Drink plenty of calorie-free, non-carbonated, caffeine- free fluids between meals . • Drink slowly-sip fluids, never gulp. • Calorie-containing beverages should be limited to skim milk and Protein Drinks. • Limit juice to no more than 4oz. per day. • Consume zero-calorie beverages throughout the day. 6 Diet Progression After Surgery The diet after gastric sleeve surgery progresses through several stages. Your surgeon will let you know when it is okay to progress to the next stage. Day 1 - 2 after surgery: Clear Liquid Diet The clear liquid diet means fluids or foods that are liquid at body temperature and can almost be seen through. You will be on a clear liquid diet while you’re in the hospital. Examples of Clear Liquid Diet (No Added Sugar/ Sugar Free): • Clear (diluted) fruit juices without added sugar: apple, grape or white grape or diet cranberry • Sugar-free Crystal Light drink mix or popsicles, sugar-free Kool-Aid • Herbal tea, caffeine-free tea • flat soda • Sugar-free Popsicles • Sugar-free gelatin • Clear broth • Water ???? It is best to dilute juices by 50% with water. ???? Avoid citrus juices (orange/grapefruit) and tomato juice for the first three weeks. ???? Coffee and de-caffeinated coffee contain acids which are irritating to the stomach lining and should be avoided for the first few weeks for healing. Day 3 through Week 2: Full Liquid Diet The next stage is the full liquid diet which consists of sugar-free, low-fat milk products and the Clear Liquids listed above. You will need to supplement with protein (drinks or powder) after surgery. Remember to sip liquids, do not gulp. Examples of Full Liquid Diet (No Added Sugar/Sugar-Free, Low Fat): • Skim Milk or Lactaid milk • Soy Milk (non-fat) • Low fat, thin, strained cream Soup (smooth, no pieces of food) • Sugar-free instant breakfast • Protein drinks – Start daily when you get home from the hospital. (See section on protein and protein drinks) • Plain or “light” (no sugar added) yogurt with no fruit pieces • Sugar-free pudding or custard • Thinned cream of wheat or rice cereal 7 Week 3 through Week 8: Pureed Diet You may now begin a pureed diet. This includes all items listed for clear and full liquids, and the items listed for the pureed (blenderized) diet. • Eat PROTEIN foods first • Make sure foods are well blended. • Start slowly. If you do not tolerate pureed foods go back to the liquid diet and try again in a few days. • Remember to drink liquids between meals, not with meals. • Continue protein drinks or protein supplements every day. Examples for the Pureed Diet (Sugar-Free/No Sugar Added, Low Fat): Eggs Cheese Pureed or blenderized scrambled eggs or egg substitute or cheese omelet; melted low-fat cheese, low-fat or non-fat cream cheese, ricotta cheese, very smooth/mashed soft cheese such as mozzarella, string cheese, low-fat or non-fat smooth or small curd cottage cheese Meat, Fish, Poultry, Baby food meat or pureed meat or poultry moistened with broth or low-fat gravy Blenderized shrimp, scallops or fish Pureed tuna or salmon (canned in water) or pureed egg salad with low-fat or non-fat mayonnaise Potted meats thinned with broth; smooth deviled ham Starches Unsweetened instant oatmeal (strained), cream of wheat or rice cereal, mashed potatoes or sweet potatoes, smooth polenta, hummus, refried beans; low-fat or baked crackers or chips Vegetables Baby food vegetables or pureed cooked vegetables (no corn or peas) Mashed winter squash, tomato juice or sauce, pureed salsa, marinara Soup Strained, low-fat cream soup made with skim milk; fat-free broth Blenderized lentil or split pea soup or chili Fruit Baby food fruits (bananas, pears, applesauce, peaches, mango, etc) Unsweetened applesauce (smooth) Unsweetened canned fruit – blenderized Unsweetened fruit juice (diluted, no sugar added) Remember: IF YOU CAN CHEW IT, DON’T DO IT! 8 Tips to Get Started Everything that you eat on the pureed diet should be sugar-free or no sugar added, low fat and blended to the consistency of baby food or smooth applesauce. • You will need a blender or food processor or you can purchase baby food. • Start with 1 ounce (2 Tablespoon) portions - no more than 4 Tablespoons at the most. Listen to your body and stop eating as soon as you feel full. • Eat protein foods first. Then if you are not too full, try vegetables or fruits. • Continue protein supplements (80 g protein per day from supplement). Helpful Hints for Blenderizing • Cut foods into small pieces before putting into the blender or food processor. • Remove seeds, skins and fat. • Add liquid for ease of blending. Add enough liquid to cover the blades. Options include skim milk, broth, strained low-fat cream soup, low-fat gravy, low-fat or non-fat sour cream or fat-free half & half. • Blend the item to a smooth, applesauce consistency. • Make sure there are no particles, seeds or lumps remaining. If so put through a sieve or strainer. • If you have leftover blenderized foods, try freezing in single serving portions in ice cube trays and put the frozen cubes into plastic freezer bags. Meats – Very lean and dry meats puree better by adding a small amount of fat (margarine, oil, light mayonnaise, gravy, etc.) Fish also tends to be dry. Improve the texture by adding small amount of lemon juice, light mayonnaise or strained low-fat tartar sauce. Starches – Try pureed peas, canned Beans, sweet potatoes. Starches puree better when hot. Rice and potatoes tend to puree into a gummy paste and are not recommended. Substitute cream of rice Cereal prepared with a flavorful broth and seasoned with margarine. Pasta or noodles are not recommended as they are not well-tolerated. Vegetables – Cook vegetables until soft. If using canned vegetables, drain first. Add melted margarine and puree. Add a small amount of liquid until it reaches the smooth applesauce consistency. Fruit – If using canned fruit, drain first. Add a few drops of lemon juice to help prevent them from discoloring. Begin to take advantage of your favorite leftovers before surgery. Process these foods, and freeze them in an ice cube tray. (Each cube is approximately 1/2 to 1 ounce). When frozen, pop out into Zip-lock bag; label and date, and freeze cubes until needed. 9 Meal Guidelines for the Pureed Diet (See Sample Pureed Meals listed in the Appendix) Once you begin to eat pureed foods (which are considered solids) you will want to start differentiating between liquids and solids – meals should include pureed foods, and so liquids (including protein drinks) should be taken separately from your meals. • You should eat 3 meals a day with protein drinks between meals. • Protein drinks containing at least 20 grams of protein per serving should be consumed as needed to meet 80 g/day goal. • Start with a portion size of 1 to 2 tablespoons of pureed food for the first month. At first you may not be able to tolerate this amount. Eat your protein source first, and then if you have room a small amount of fruit, vegetables or other foods may be consumed. Hints for Measuring Foods: Liquids or soft/pureed foods are best measured in measuring cups or spoons; they can be measured in ounces, Tablespoons or mls. 1 cup 8 Fluid ounces 240 ml 16 tablespoons 3/4 cup 6 fluid ounces 180 ml 12 tablespoons 1/2 cup 4 fluid ounces 120 ml 8 tablespoons 1/4 cup 2 fluid ounces 60 ml 4 tablespoons 1/8 cup 1 fluid ounce 30 ml 2 tablespoons 1 Tablespoon = 3 teaspoons 1/2 Tablespoon = 1-1/2 teaspoons Week 9-12 After Surgery: Soft solid food Diet If you have been tolerating pureed foods, you may now begin a soft diet. This includes all items listed for clear and full liquids and pureed diets plus items listed for the soft diet. Try 1 to 2 new foods a day. This will help you to learn what foods you tolerate. • Remember your stomach pouch empties more slowly with more solid or dense foods than with liquids, so you will be able to tolerate a smaller quantity of food than you could with liquids . • Go slowly. If you do not tolerate the trial of soft foods, resume pureed foods and try again in a week. • Eat protein foods first • Avoid foods high in sugar and fat. • Space meals 4-5 hours apart • Continue your protein drinks between meals • Drink other fluids constantly between meals 10 Examples of Soft Diet (No Added Sugar/Sugar-Free, Low Fat): • Baked fish (no bones) • Imitation crab meat, baby shrimp • Bananas • Canned peaches or pears in water or juice • Well-cooked vegetables without seeds or skin (no corn or peas) • Scrambled, poached or hard boiled eggs • Tuna or egg salad (no onions, celery, pimientos, etc.) • Finely shaved deli meat • Baked, grilled or rotisserie chicken o Moist foods will be better tolerated. Moisten meats with broth, low fat mayonnaise, or low-fat gravy or sauce. o Fish and seafood Proteins are softer and easier to break down than poultry or red meat proteins. o Reheating foods tends to make them dry out and hard to tolerate. Common Problem Foods (Avoid for 3 months after surgery) • Red meat such as steak, roast beef, pork. Red meat is high in muscle Fiber, which is difficult to separate even with a great deal of chewing. Avoid hamburger for one month after surgery. • Un-toasted bread; rolls, biscuits. (Toasted bread may be better-tolerated.) • Pasta • Rice • Membrane of citrus fruits • Dried fruits, nuts, popcorn, coconut • Salads, fresh fruits (except banana) and fresh uncooked vegetables, potato skins. Month 4 After Surgery: Regular Diet • Problem foods as listed above can now be tried. • Rice, pasta and doughy bread may not be tolerated for 6 months or more. • Try fresh fruits without the skin first. If tolerated, the skin can be tried the next time. Salads are generally well-tolerated if chewed well. • Go slowly. Try a small amount to see how you feel. • Avoid high sugar and high fat foods to avoid a high calorie intake. 11 Foods to Avoid : Hard/crunchy foods may always be poorly tolerated. Nuts and seeds are difficult to break down. Fried foods/greasy foods are hard to digest and are very high in calories. • Corn chips, potato chips, tortilla chips, hard taco shells • Nuts and seeds • Fried foods and greasy foods Points to Remember: • Solid foods will fill your stomach pouch more than liquids so you will be eating smaller quantities of foods versus liquids. • If you don’t tolerate a food the first time, wait a week and try again. • You may find that you tolerate a certain food one day and not the next. It is normal for this to happen. • If you don’t tolerate certain foods or notice nausea, vomiting or diarrhea during or after eating, ask yourself the following questions: o Did I chew to a paste consistency? o Did I eat too fast? o Did I eat too much volume? o Did I drink fluid with my real meal or too close to my meal? o Did I eat something high in sugar or fat? o Was the food moist or was it too dry? Steps for adding solid foods: • Try only 1 small bite of the new food and chew well. Wait awhile and if there are no problems, take another bite. • If at any time you feel too full, nauseated or vomit, stop eating and rest. Take only clear liquids at the next meal and add blended foods and liquids at the following meal. Try one solid food again the next day. 12 PROTEIN Protein is the most important nutrient to concentrate on when resuming your diet. Because the volume of your meals will be limited, you should aim for a minimum of 80 grams of protein per day – this needs to come from your protein supplement . Why is protein important? • Wound healing • Sparing loss of muscle • Minimizing hair loss • Preventing protein malnutrition Remember to eat protein foods first at each meal, followed by vegetables and fruit. These are some good sources of protein: Protein Sources Serving size Protein (g) Skim or 1% milk 1 cup 8 Evaporated skim milk (canned) 1 cup 19 Soy milk beverage 1 cup (8 ounces) 7 Non fat dry milk powder 1/3 cup powder 8 Nonfat, sugar free yogurt 1 cup (8 ounces) 8 Nonfat or low fat cottage cheese ½ cup (4 ounces) 14 Nonfat or low fat cheese slices String cheese *1 ounce/ 1 slice 6 LEAN meats – skinless chicken or turkey breast, fish, beef, ham, Deli meats *1 ounce 7 Egg or Egg substitute 1 egg or ¼ cup subst. 7 Peanut Butter (creamy) 1 Tablespoon 5 Tofu ¼ cup 5 Legumes; dried beans peas or lentils Chili, bean soup ½ cup cooked ½ cup 7-9 6-7 Soy/vegetable patty (like Gardenburger) 1 patty 8 - 10 Hummus ½ cup 6 Measuring Hints: *1 ounce of meat is equal to about 3 – 4 Tablespoons of chopped or ground meat. 1 ounce of grated or cottage cheese, tuna or egg salad is ~ 1/4 th cup (4 Tablespoons). A 3-ounce portion size of chicken or meat is about the size of a deck of cards. 13 High Protein Ideas Chicken or Turkey Pureed – Use baby food or make your own. Try mixing it into strained low-fat cream soup. Breast – baked or grilled Thin-sliced/shaved deli slices Ground – meatballs, meatloaf Canned – works great for chicken salad Strained out of canned soup – tends to be very moist Fish (avoid bones) Baked, broiled, poached, or grilled fish Shrimp Imitation or regular crab meat Fresh or canned salmon in water Canned tuna in water Sushi Beef or Veal (Extra Lean) Ground – meatballs, meatloaf Pork Shaved deli ham Eggs or Egg substitute Scrambled eggs or omelet Homemade eggnog made with skim milk, sugar-substitute Diet custard Egg salad Quiche or frittata Deviled eggs Low-fat Dairy Products Milk (skim or 1%) Yogurt (plain or no-sugar added) Low-fat cheeses including cottage cheese, string cheese, ricotta, or any other cheeses which are reduced-fat or non-fat. Legumes Peanut Butter – smooth Dried beans or lentils – or Soups, stews or chili made from these Hummus Vegetarian or fat-free refried beans Tofu 14 Protein Supplements ???? Because of the limited volume capacity of the stomach, it will be nearly impossible to meet your protein needs from food sources for up to a year after surgery. ???? You will need to consume a protein drinks to get a total of 80 g protein per day – This would be 2 protein drinks with 40 or more grams per serving, or 4 servings of a protein drink with 20 grams of protein per serving. ???? Once off of the liquid diet, it is best to consume your protein drinks between meals, rather than as a meal. How to choose a protein supplement: • Review the label to find a product that is high in protein, low in carbohydrate or sugar and low in fat. • Choose a product with at least 20 grams or more of protein per serving. • Whey protein is preferable, especially whey protein isolate. • Choose a product that is low-sugar or sugar-free and sweetened with sugarsubstitutes such as Nutrasweet (Aspartame) or Splenda (Sucralose) or Acesulfame K. The sugar content listed on the label should be no more than 6 grams per serving. • Avoid drinks such as Ensure, Boost, or Slim Fast. They tend to have a lot of carbohydrate and fat compared to pure Protein Powder mixed with skim milk or water. • Choose a product that is low fat: no more than 3 grams of fat per 100 calories. (For example, Atkins shakes tend to be too high in fat and are not recommended). Where to purchase protein drinks: • GNC • Super Supplements • Trader Joe’s • Fred Meyer • Wal-Mart • Rite-Aid • Walgreen’s • Grocery store pharmacies • On-line (www.Bariatriceating.com) 15 Commercial Protein Supplements Unjury (Flavored or Unflavored powder). 20 grams of protein per scoop. Mix with 6-8oz. skim milk, water, or yogurt Order at www.UNJURY.com or (800) 517-5111 or (703) 925-9390 Check the websites for recipes using Unflavored unjury protein powder. Optimum 100% Whey Protein 1 scoop powder = 24 grams protein Zero Carb Isopure 2 scoops powder = 50 grams protein Available at GNC Met-Rx Protein Plus Whey 2 scoops powder = 46 grams protein Designer Whey Protein Supplement 1 scoop powder = 17.5 grams protein Available at Rite-Aid, Super Supplements EAS 100% Whey Protein 2 scoops powder = 23 grams protein Zero Carb Isopure Ready to Drink 40 grams protein per 20 ounces serving Fruit flavors (clear liquid) EAS Myoplex Carb Sense Ready to Drink Liquid product 25 grams protein per serving MetRxUltra Pure Protein Shake (Ready to Drink) Liquid product 35 grams protein per 11 oz. Worldwide Pure Protein (Ready to Drink) Liquid product 35 g protein per 11 ounces (Available at Trader Joe’s, most large drugstore/pharmacies) Cytosport Protein Pure Performance Drink 40 g protein per 20 ounce bottle Tangerine and Watermelon flavors, clear liquid Available at NW Prescriptions 16 These products are available from Bariatriceating.com: (This website has a large selection of protein powders and ready to drink products. Check the website frequently for availability.) Micellar Milk Ready to Drink 40 g. protein in a 17 ounce serving New Whey Liquid Protein “Bullets” 3 ounce plastic container – 42 g protein, 2 g carbs Orange, Grape or Fruit Punch flavors AchievOne – Ready to drink (contains coffee) 20 g protein per 9 ounce serving Whey Gourmet 23 grams protein per scoop Comes in 12 flavors Nectar 23 grams protein per scoop Also available in single scoop packets Any Whey Tasteless Protein 17 grams protein per small scoop Add to soups, chili, eggs, etc. IsoFruit Delite Protein Cocktail Refreshing Cantaloupe or pineapple flavored 21 grams protein per scoop Matrix Protein 23 grams protein per scoop Elite 22 grams protein per scoop IDS 23 grams protein per scoop Protein Delite on the Go (plastic bottle with pre-filled powder) (contains dried fruit or chocolate bits) 25 grams protein in 8 ounces Additional ideas for adding protein to foods: 17 • Non-fat dry milk powder can be added to milk, hot cereal, cream soups, mashed potatoes, or casseroles – 1/3 cup powder = 8 g protein. • Egg white powder – can also be added to foods as listed above. Adds approximately 6 grams protein per 2 Tbsp. (check label protein content may vary by brand.) Sold at the grocery store (in the baking section). Hints to add variety to your protein drinks: • Flavor extracts or spices that do not contain sugar can be added to protein drinks for flavor. Examples: vanilla or almond extract, cinnamon or nutmeg. • Sugar-free cocoa powder can be added to provide a chocolate flavor. • Instant decaffeinated coffee can be added to drinks or yogurt for a flavor change. • Sugar-free Tang can be added to vanilla drinks to create an orange creamsicle flavor or try adding to an unflavored Protein Drink. • Sugar Free Kool-Aid or Crystal Light powder can be used to flavor protein drinks • Sugar-free syrups can be added to flavor protein drinks • If a drink tastes too thick or too sweet try adding more milk or water. • Mixing with milk provides additional protein and Calcium. • Try freezing your protein drinking after preparing. This can be consumed with a spoon as a frozen treat. Also can be made into “popsicles”. • Try adding ice to the prepared protein drink and blenderize to make a slushy. • Try mixing your protein powder with plain or sugar-free vanilla yogurt. • Try mixing protein powder into sugar-free Gelatin (before it is set). 18 Daily Vitamins and Minerals You are required to take the following vitamin and mineral supplements every day for the rest of your life. Taking a vitamin and mineral supplement is vital to maintain your nutritional health and prevent vitamin and mineral deficiencies. You are now at greater risk for decreased absorption of vitamins and minerals because you are eating a significantly smaller amount of food in a day. o All pills must be crushed, chewed or liquid for the first month after surgery or as directed by your physician. Multivitamin with Minerals (Start the first day that you get home from the hospital). First 6 weeks following surgery • 2 children’s complete chewable Multivitamins with minerals or 2 adult chewable multivitamin/mineral supplements to provide twice the adult RDA. • Take with meals, one in the morning and one in the evening. • Examples: One A Day Children’s Complete, Flintstones Complete. Centrum Children’s Complete, or Centrum Chewable for adults, Kirkland (Costco brand) chewable multivitamin Week 6 after surgery • Decrease to 1 multivitamin with minerals tablet daily for the rest of your life. • Take with a meal. • If the multi-vitamin/mineral supplement makes you nauseous, do not take it on an empty stomach—take it with food or at night. 19 Fluids • Do not drink liquids ½ - 1 hour before, during, or ½ - 1 hour after meals. Drinking liquids with meals or too close to mealtime may cause bloating, nausea, or vomiting. It is best to drink a lot of liquids between your meals • Fluid intake is very important for prevention of dehydration and constipation; adequate water is essential to help rid the body of waste, maintain proper muscle tone and prevent sagging skin. • Sip on water all day between meals. A water bottle with a sport top is a good way to get small sips of water and to avoid gulping. Sucking on ice will also help with fluid intake. • Your initial fluid goal should be a minimum of 4 cups (32 oz. or one quart) of caffeine-free, sugar-free fluid per day. At least half of this should be from water. You should be able to consume this amount within a few days after surgery. Gradually, you want to increase your fluid intake to at least 8 cups (64 oz.) a day. • Do not use a straw. This can cause your stomach to fill with air, causing distention, gas and bloating. • Try varying the temperature of liquids for variety and tolerance. • Most fluids should be non-caloric such as water, Crystal Light, sugar-free Kool- Aid, decaf coffee, unsweetened or artificially sweetened tea, or broth. Avoid all sugar-sweetened beverages. • Fruit juice should be 100% fruit juice with no sugar added. Limit to no more than 4 oz. per day and dilute with 4 ounces of water. • Limit caffeine to no more than 4 ounces per day. • Avoid carbonated beverages and sodas. Flat (diet) soda may be better tolerated. • Avoid alcoholic beverages. They do not have any nutritional value and may cause weight gain and/or liver damage. 20 Sugar and Fat Foods high in sugar and foods high in fat should be avoided due to the high caloric content. Consuming high calorie foods can slow weight loss and even cause weight gain. Be careful to avoid soft calories. Soft calories are foods or liquids that are high in calories and easily tolerated (soft or liquid). This includes items such as chocolate, ice cream and high calorie liquids such as milkshakes, regular soda or soft drinks, sweetened drinks, and alcoholic beverages. Avoid sugar (this also means honey, syrup, molasses and other caloric sweeteners), and foods high in sugar or with sugar added, such as candy and sweets; baked goods such as cookies, brownies, doughnuts, cake, pastries, pie, cobbler; frozen desserts such as ice cream, sherbet, sorbet, frozen yogurt, milkshakes; sweetened cereals; fruit canned in syrup; regular jams, jellies and preserves. Fats High fat foods should be avoided because they are very high in calories. • Avoid fried foods. Remove all visible fat and skin from meats and poultry. • Avoid fast foods. • Choose low fat or fat free products. • Avoid high fat dairy products such as whole milk, full fat cream, cheese or sauce. • Avoid high fat pastries, donuts and desserts. • Avoid high fat meats such as bacon, sausage and hot dogs. • Limit added fats such as butter, margarine, lard, regular mayonnaise or spreads, and regular salad dressing. Try the fat free or low fat alternatives. • Avoid “snack foods” such as potato chips, tortilla chips, cheese curls. You need to eat some “healthy fats” daily (for example, vegetable oils such as olive, canola or soybean; nuts or nut butter, or avocado). However, since they are so high in calories, they need to be limited to no more than 2 – 3 teaspoons total per day. 21 Possible Complications Nausea/Vomiting This is often caused by eating too much – taking too big of a bite, eating too fast, not chewing well enough or drinking liquids with solid foods. It can also be caused by lying down after meals, or eating foods that may not agree with you. Be sure to eat in a slow, calm manner. • Call your doctor if you are having frequent or persistent vomiting. Hair Loss Hair loss is a side effect of weight loss surgery. You may not see hair loss initially due to the time it takes hair to grow from the root. You will see hair loss or breakage as the hair grows through the scalp. Often it takes several months after surgery for hair loss to show; and several more months for you to see the hair start growing back. Hair loss can occur from a low protein and zinc intake, and a severe decrease in overall nutrition intake. You must take in a minimum of 70 grams of protein per day. Adequate protein intake may help reduce (but not prevent) hair loss. If protein intake is meeting the minimum recommended guidelines and hair loss continues to be bothersome, you can try supplementing with zinc (no more than 50 mg per day.) Ongoing hair loss can also be a sign of iron-deficiency anemia. Constipation Constipation after surgery is common, but can be prevented. It is usually due to a decreased intake of fiber-containing foods; also, Iron in the Multivitamin supplements can be constipating. Tips to prevent constipation • Drink plenty of fluid -- a minimum of 8 cups (64 ounces) per day. • Exercise regularly. • Try baby food prunes or unsweetened diluted prune juice or oatmeal. When you are allowed to resume regular foods, you can start eating high fiber foods such as high fiber cereals (3 or more grams of fiber per serving), fresh fruits, fresh vegetables and legumes. • Add high-fiber foods gradually • Chew all fiber-containing foods very well. • Drink plenty of fluids when increasing fiber in the diet. If constipation persists, try a daily fiber supplement. Inulin-based soluble fiber supplements such as Fiber Sure are less prone to cause bloating. * If constipation continues, call your doctor; do not take laxatives without consulting your doctor first. 22 Key Points to remember 1. You may never be able to eat the portions you consumed prior to surgery. 2. For a safe weight loss, you need to eat a healthy, well balanced diet. 3. Be sure to make healthy food choices to obtain the most nutrition per serving. 4. Choose low-calorie, nutrient-dense foods. 5. Be patient. At first, you will fill up after just a few bites. This is normal. Stop eating when you feel full. 6. Initial meal size should be approximately 1 – 2 oz. (2 - 4 Tbsp) per meal, 3 meals per day. Volume tolerance will increase after healing (usually about 2 to 4 ounces). Continue to eat slowly, chew foods thoroughly and drink in-between meals. 7. When you try a new food, take one bite to see if it is comfortable for you. 8. You must take the recommended multivitamin/mineral supplement every day for the rest of your life. 9. You should consume protein drinks or supplement with protein powder until your protein intake from foods is adequate. 10. Following the recommended diet rules will help you to lose weight and keep it off. 11. Your dedication to diet, exercise and lifestyle changes will dictate your success after surgery. 12. You can defeat the surgery, resulting in weight gain. 13. Grazing, drinking fluid with meals, or consuming high calorie foods or liquids are examples of ways that the surgery can be defeated. 14. Keep a food and exercise diary. Record the time of meals, food consumed, portion size and preparation method. (You may be asked to bring a food and exercise diary to your surgeon and/or dietitian visits.) 15. Attend Bariatric Support Group meetings on a regular basis before and after surgery. 16. Exercise regularly and follow your doctor’s orders or restrictions when exercising. Continue to follow the guidelines provided throughout this education packet. You have been provided the tools necessary to achieve and maintain a healthy weight loss. 23 Checklist : The following tasks should be completed before surgery: ___ Purchase supplements: ___Protein Supplements – try to have a variety of ones you like ___Multivitamin/mineral supplement ___Any needed equipment (see Equipment Checklist in Appendix) ___Any other foods and beverages you will need during the liquid and blenderized phases of the diet (Review diet sections) ___ Prepare some pureed foods to be used after surgery ___ Complete Meal, Supplement, and Exercise Schedule (see example in Appendix) ___ Keep working on these behaviors to make them become habits: • Practice eating meals without liquids • Practice taking small bites and chewing thoroughly • Pay attention to what you are doing while you are eating • Try to make your meals last at least 30 minutes • Sip fluids slowly – do not gulp! • Begin to wean yourself from caffeine • Find alternatives to coffee and sodas • Do not chew gum • Do not use straws • Find ways to incorporate 30 minutes of activity into your daily routine. Resources: The following websites are highly recommended: www.bariatriceating.com www.obesityhelp.com These books may be helpful: Exodus from Obesity – The Guide to Long-Term Success After Weight Loss Surgery by Paula F. Peck, RN Eating Well after Weight Loss Surgery by Patt Levine and Michele Bontempo-Saray Websites for calculating calorie and protein intake: www.fitday.com www.sparkpeople.com 24 Appendix: Equipment Check List The following is a list of helpful items to consider. For your Dining Pleasure: ___ Baby Spoon, Cocktail Fork (Helps you to take small bites) ___ Small Decorative Plates (Helps control portions and increases the eye appeal of the meal) ___ Insulated dish or warming plate (Helps keep food warm while you slowly enjoy your meal) ___ Sippy Cup (For those that have difficulty with gulping liquids) ___ Water bottles with a sports top (Re-use to carry other sugar free, non-carbonated beverages with you Other ideas – candles, new placemats, and fresh flowers to create a pleasurable eating experience at the table… For Meal Preparation These are vital pieces of equipment: ____ Mini food processor/food chopper ____ Hand Blender or the “Magic Bullet” (available at Walgreen’s) ____ Measuring spoons and cups ____ Small kitchen scale These are very helpful: ____ Extra ice Cube Trays ____ Small Freezer bags ____ Permanent Marker or freezer labels ____ Small plastic containers OR ____ The Food Saver (to vacuum pack foods) (A $100 investment, available at Wal-Mart) For Medications: ____ Pill Crusher ____ Pill Splitter ____ Large pill case (1 week’s worth) 25 Appendix: Pureed Diet Sample Meals: The following are ideas for pureed meals. Each meal consists of about ¼ cup. Use your own creativity to add variety to your diet. Spices and seasonings are not limited after surgery. Remember to make each of your 3 daily meals protein-based and include the essential fats (i.e., margarine, mayonnaise, oil) in your food preparation. Example 1: 2 Tbsp of a pureed cheese omelet made with Eggbeaters 1 Tbsp hot cereal 1 Tbsp sugar-free or plain yogurt Example 2: 2 Tbsp blended low fat cottage cheese 2 Tbsp pureed fruit (i.e., applesauce, peaches, pears or baby food fruit) Example 3: 1 Tbsp smooth peanut butter 2 saltine crackers 1 Tbsp pureed fruit (banana) Example 4: 2 Tbsp grated cheese 1 Tbsp polenta 1 Tbsp pureed roasted vegetables or marinara sauce Example 5: 2 Tbsp fat-free refried beans or hummus 2 baked tortilla chips 1 Tbsp grated cheese; garnish with pureed salsa and low-fat sour cream Example 6: 2 Tbsp mashed tuna or salmon salad made with 1 tsp light mayo 2 low-fat crackers 1 Tbsp pureed fruit or baby food fruit Example 7: 2 Tbsp mashed/smooth egg or chicken salad made with 1 tsp light mayo 2 low-fat crackers 1 TBS pureed fruit or diet pudding Example 8: 3 Tbsp ricotta cheese 1 Tbsp marinara sauce 1 Tbsp pureed roasted vegetables Example 9: 2 Tbsp pureed turkey or chicken with 1 tsp gravy or broth 1 Tbsp mashed potatoes or sweet potatoes 1 Tbsp pureed vegetable or fruit Example 10: 2 Tbsp pureed crab or lobster with 1 tsp light mayonnaise Sprinkle with Old Bay Seasoning 1 Tbsp pureed acorn squash 1 Tbsp pureed fruit Example 11: 2 Tbsp pureed chili 2 Low fat crackers 1 Tbsp diet pudding 26 Appendix: Meal Schedule Example Sample: Your Schedule: Time Meal/Supplement Or Vitamin Time Meal/Supplement or Vitamin 7:00 – 7:30 Meal 1 Multivitamin 8:15 Start Fluids 9:00 Walk 15 minutes 10:00 Protein Supplement 11:15 Stop Fluids 12:00 – 12:30 Meal 2 1:15 Start Fluids 3:00 Protein Supplement 4:15 Stop Fluids 5:00 – 5:30 Meal 3 Multivitamin 6:15 Start Fluids 7:00 Walk 15 minutes 8:00 Protein Supplement Daily Goals: Drink a minimum of 64 ounces of fluid. Sip fluids between meals Walk for 30 minutes Eat 3 meals and Protein Shakes to meet protein needs Supplements: Multivitamin – 2 chewables daily with meals (after 6 weeks, may use 1 tablet per day, cut small) Reminders: Meals should be 4 to 5 hours apart Do not drink 30 – 60 minutes before, during or 30 – 60 minutes after a meal No alcohol No carbonated beverages No caffeine No acidy or citrus juices/foods/beverages for first month 27 BEHAVIOR MODIFICATION TECHNIQUES 1. Don’t eat in front of the TV. 2. Don’t read while eating. 3. Pre-portion your food and put the box or package away. 4. Keep tempting foods out of the house. 5. Don’t go to the grocery store hungry. 6. Make a shopping list. 7. Use smaller plates and bowls. 8. Keep healthy foods available. 9. Focus on activities other than eating. 10. Brush your teeth after meals or if feeling the desire to eat. 11. Don’t eat standing up at parties or buffets. 12. Don’t stand at the food table at the parties. 13. Offer to bring a healthy food item to a party. 14. Park your car far away from your destination. 15. Get up to change the TV channel instead of using the remote control. 16. Take the stairs instead of the elevator. 17. Keep a food and exercise diary.

I'm not a big soda fan but I do drink beer pretty much every weekend. It's fine with my Doc, just don't forget to account for the extra calories. There is no "standard procedure". Every doc is different. My theory is that you need to follow the advice of the person you will turn to if you have a problem, as in your doctor. If you think your doc is full of crap, find another one. Reading the forums you will see that there is a WIDE range of doctor's opinions. My doc is at one end of the spectrum, I had no pre-band diet, no comments on smoking, solids after one week, I can eat or drink anything I want (just less than before), no limitations on caffeine, alcohol, carbonation, etc. He does "fill holidays" where he'll unfill you before a vacation and fill you back up afterwards for the price of one fill. His attitude is you still need to live life to the fullest. Your doc may be different. I chose mine carefully after talking to a few docs because he made sense to me. As long as you listen to your doc and don't cheat with sliders, you will lose weight. I hit 100% of my goal in about a year and now at 1.5 years I'm 10 lbs under. No complications and no stress, scale watching or calorie counting. I'm not on a diet, I have permanently changed my behavior. This is what works for me. YMMV.

I find sugar alcohols and other artificial sweeteners make me gassy and they also cause me to crave carbs so I don’t consume them anymore. Problem solved. YMMV I’ve heard of Devrom but have never tried it. I think folks in the DS Surgery Forum may have more experience with it so you might try posting your question over there. Good luck! P.S. Eating processed food /simple carbs (e.g. cereal) could also be contributing. I would minimize eating them as they may impair weight loss & maintenance, and could cause smelly gas. Do you have the issue if you just eat dense protein and vegetables and nothing else?

I was diagnosed with an ulcer at the anastomosis at six months post-op. I was fortunate to not have any symptoms other than mild anemia. They did a stool test and picked up some blood which was followed by an endoscopy that confirmed the ulcer. My surgeon doubled my Prevacid along with some restrictions in diet and a second endoscopy five months later showed the ulcer completely healed. Ulcers at the anastomosis are relatively rare, affecting 7% to 15% of patients and can be caused by any number of things including alcohol, spicy food, caffeine, smoking, the use of NSAIDs and increased retention of stomach acids in the pouch just to name a few. Treatment options vary widely from oral medication to additional surgery in serious (but rare) cases. Ulcers are one more very good reason to do everything you possibly can to follow your surgeon's post-op protocol as closely to the letter as you can. But even patients who follow the protocol can develop ulcers from causes beyond our control. Regardless of the cause, ulcers are almost always treatable and can often be completely resolved.

Nooooo!!! Don't do it!!!! I know a guy that didn't wait until his year was up before drinkng and one night he thought he was dying!!!! He went to ER and they said the alcohol had started to eat his stitches/pouch away!! That's why your on this HUGE diet a year out b/c it takes your stomach that long to heal!

I heard bariatric patients turn into alcoholics....is this true? How do you feel about drinking booze?

What is with the trolls on this site? People who do nothing but attack others. This site is proving to be a negative to others trying to get help. It is not "keeping it real" to call people idiots, slackers and lazy. I mean do people need this much attention to attack people with their little fake names? Overweight people have had ENOUGH name calling and negativity. I am going to start a positivity page on FB and will give the link. Yes people screw up. Sometimes big time. And it takes courage and guts to admit it. It takes no courage to brag about how much you are better and smarter and more wonderful at having a sleeve. PS I am a drug and alcohol counselor so my page will be about positive reinforcement. Lashing out at someone DOES NOTHING BUT STROKE YOUR OWN EGO. I can't believe there is no one admining this site. I hope the trolls get their little fix when they drive everyone away from this community. Sent from my iPhone using the BariatricPal App

I got the band because I didn't want to have my insides rerouted. I also wanted to be able to eat sweets and drink alcohol if I so choosed. Best of luck with your decision. Either way you will get healthier.

What are ketones? Ketones are a normal and efficient source of fuel and energy for the human body. They are produced by the liver from fatty acids, which result from the breakdown of body fat in response to the absence of glucose/sugar. In a ketogenic diet, such as Atkins ... or diets used for treating epilepsy in children, the tiny amounts of glucose required for some select functions can be met by consuming a minimum amount of carbs - or can be manufactured in the liver from Protein. When your body is producing ketones, and using them for fuel, this is called "ketosis". How will ketosis help me to lose weight? Most reducing diets restrict calorie intake, so you lose weight but some of that is fat and some of it is lean muscle tissue as well. Less muscle means slowed metabolism, which makes losing weight more difficult and gaining it back all too easy. Ketosis will help you to lose FAT. Being in ketosis means that your body's primary source of energy is fat (in the form of ketones). When you consume adequate protein as well, there's no need for the body to break down its muscle tissue. Ketosis also tends to accelerate fat loss --- once the liver converts fat to ketones, it can't be converted back to fat, and so is excreted. But, isn't ketosis dangerous? Being in ketosis by following a low carbohydrate diet is NOT dangerous. The human body was designed to use ketones very efficiently as fuel in the absence of glucose. However, the word ketosis is often confused with a similar word, ketoacidosis. Ketoacidosis is a dangerous condition for diabetics, and the main element is ACID not ketones. The blood pH becomes dangerously acidic because of an extremely high blood SUGAR level (the diabetic has no insulin, or doesn't respond to insulin .... so blood sugar rises ... ketones are produced by the body to provide the fuel necessary for life, since the cells can't use the sugar). It's the high blood sugar, and the acid condition that is so dangerous. Ketones just happen to be a part of the picture, and are a RESULT of the condition, not the CAUSE. Diabetics can safely follow a ketogenic diet to lose fat weight ... but they must be closely monitored by their health care provider, and blood sugars need to be kept low, and stable. How do the ketone test strips work, and where can I get them? Ketone urine-testing strips, also called Ketostix or just ketone sticks ... are small plastic strips that have a little absorptive pad on the end. This contains a special chemical that will change colour in the presence of ketones in the urine. The strips may change varying shades of pink to purple, or may not change colour at all. The container will have a scale on the label, with blocks of colour for you to compare the strip after a certain time lapse, usually 15 seconds. Most folks simply hold a strip in the flow of urine. Other folks argue that the force of the flow can "wash" some of the chemical away, and advise that a sample of urine be obtained in a cup or other container, then the strip dipped into it. The chemical reagent is very sensitive to moisture, including what's in the air. It's important to keep the lid of the container tightly closed at all times, except for when you're getting a strip to take a reading. Make sure your fingers are dry before you go digging in! They also have an expiry date, so make note of this when you purchase the strips ... that's for the UNopened package. Once opened, they have a shelf-life of about 6 months -- you may wish to write the date you opened on the label for future reference. Ketone test strips can be purchased at any pharmacy, and are usually kept with the diabetic supplies. In some stores they're kept behind the counter, so if you don't see them on the shelf, just ask the pharmacist; you don't need a prescription to buy them. I'm following Induction strictly; why won't my strips turn purple? Ketones will spill into the urine ONLY when there is more in the blood than is being used as fuel by the body at that particular moment. You may have exercised or worked a few hours previously, so your muscles would have used up the ketones as fuel, thus there will be no excess. You may have had a lot of liquids to drink, so the urine is more diluted. Perhaps the strips are not fresh, or the lid was not on tight and some moisture from the atmosphere got in. Some low carbers NEVER show above trace or negative even ... yet they burn fat and lose weight just fine. If you're losing weight, and your clothes are getting looser, you're feeling well and not hungry all the time .. then you are successfully in ketosis. Don't get hung up on the strips; they're just a guide, nothing more. Will I lose weight faster if the strips show dark purple all the time? No. Testing in the darkest purple range all the time is usually a sign of dehydration -- the urine is too concentrated. You need to drink more Water to dilute it, and keep the kidneys flushed. The liver will make ketones from body fat, the fat you EAT, and from alcohol --- the ketone strips have no way of distinguishing the source of the ketones. So, if you test every day after dinner, and dinner usually contains a lot of fat, then you may very well test for large amounts of ketones all the time. However this does not indicate that any BODY fat was burned. The strips only indicate what's happening in the urine. Ketosis happens in the blood and body tissues. If you're showing even a small amount, then you are in ketosis, and fat-burning is taking place. Don't get hung up on the ketone sticks. Does caffeine affect ketosis? This is questionable. There ARE a few studies that suggest caffeine may cause blood sugar to rise, with consequent effect on insulin ... The studies involve consuming 50 gm glucose orally, followed by a dose of caffeine. This is quite different from a low carber, who is consuming only 20 gm carbs, in the form of high-fiber vegetables, spread throughout the day. Many low carbers continue to enjoy caffeine-containing beverages with no serious impact on their weight-loss efforts. However, there are some sensitive individuals ... and persons who are extremely insulin resistant may need to restrict or even eliminate all caffeine. If you have been losing successfully then find your weight loss stalled for a month or two, and you are following your program to the letter, you might consider stopping all caffeine for a while, to see if that will get things started again. Will drinking alcohol affect ketosis? No and yes. The liver can make ketones out of alcohol, so technically, when you drink you'll continue to produce ketones and so will remain in ketosis. The problem is ... alcohol converts more easily to ketones than fatty acids, so your liver will use the alchol first, in preference to fat. Thus, when you drink, basically your FAT burning is put on hold until all the alcohol is out of your system. This rapid breakdown of alcohol into ketones and acetaldehyde (the intoxicating by-product) ... tends to put low carbers at risk for quicker intoxication ... especially if no other food is consumed to slow absorption.

All your doing is being a cowardly jerk hiding behind a computer telling people off and scaring them from being honest. I guess this is a site where everyone lies and says how perfect their journey is or they will be attacked by bullies. A lot of people got the point across that it could hurt him without being an obnoxious ass. Get over yourself and stop trolling.Sent from my iPhone using the BariatricPal App Yes. I see how positive and supportive you are. You are a drug and alcohol counselor yet this is how you behave? This is the language you use? WOW. What's that phrase about a pot and a kettle? Well, wait a minute. Her posts you quoted almost look like....trolling? But that's impossible! She just stated she's a big advocate for positive reinforcement! Also, as someone who has been involved in 12 Step programs my entire life, NO drug and alcohol counselor enables dangerous behavior. When a heroin attic comes to you who has relapsed, do you tell them "That's okay! Everyone makes mistakes!"

My program truly stresses the link between WLS and alcoholism...to the point that every professional in the process: nutritionist, psychologist, nurses and surgeons mention it. I chose to stop drinking 6 months prior to surgery and have no desire to resume...just like I've chosen not to eat white bread, rice, or potatoes. But, I also wonder if some WLS patients have an issue with alcohol because they've heard about the dangers so often.

I use Jay Robb protein if anyone is interested in a protein mix that doesn't contain artificial sweeteners. I'm allergic to splenda (sucralose) and sugar alcohols. Just in case anyone else is sensitive or allergic as well. sweetened with stevia and the best tasting I've found.